Colectomy is the surgical resection of any extent of the large intestine and is often the clinical endpoint intervention for medical indications such as colon cancer and inflammatory bowel disease (IBD), for example UC.
While the understanding of the etiology of UC has grown over the years, the picture emerging is one of a complex interplay between genetic (Cho and Brant, 2011; Thompson and Lees, 2011), microbial (Wine et al., 2010) and environmental factors (Cosnes, 2010) as well as intestinal epithelial function (Schmitz et al., 1999) and mucosal immune system (Heller et al., 2002). No factor alone appears to be sufficient to trigger the development of the disease and the contribution of each individual component may vary between patients (Xavier and Podolsky, 2007). Clinical presentation of UC depends upon the extent and severity of the disease however predominate features includes blood in stool, stool frequency, passage of mucopus and possible abdominal pain (Riegler et al., 2000).
Effective clinical management of active UC requires a comprehensive understanding of the disease extent, the severity and the potential risks and benefits of the available interventions with focus on the induction and maintenance of remission. Corticosteroids remain the cornerstone of initial therapy yet a third of patients will fail to respond, and further management involves critical and timely decisions on whether to use rescue therapy in the form of immunomodulatory drugs such as Ciclosporine A or anti-TNF therapies such as Infliximab (Turner et al., 2007). Current data suggest that rescue with Ciclosprine A and Infliximab are efficacious in the short to medium term perspective (Wilhelm et al., 2008; Filippi et al., 2011) but the long term outcome seems less efficacious (Sjöberg et al., 2011). Furthermore, a significant proportion of UC patients will have recurrent flares or chronic continuous disease despite receiving conventional symptomatic treatment and within a 10 year period, some 20 percent of these patients will require surgical intervention (Langholz et al., 1994).
While surgical intervention may be curative and provide a better quality of life (Weinryb et al., 1995), it is not without considerable risks to the patient (Ferrante et al., 2008) and the procedure itself presents a significant pre- and postoperative morbidity as well as an economic burden to the healthcare system (Rubin et al., 2009). Consequently, there is an urgent need for alternative treatments.